What is the recommended duration for prophylactic famotidine (Famotidine) administration in the Intensive Care Unit (ICU) after initiating oral nutrition?

Famotidine prophylaxis in ICU patients should be discontinued once the patient is tolerating enteral nutrition adequately, typically within 24-48 hours after successful diet initiation. There is no definitive guideline for exact duration, but continuing stress ulcer prophylaxis beyond this point offers minimal additional benefit while increasing risks of adverse effects. When discontinuing famotidine (typically dosed at 20mg IV/PO twice daily in the ICU), no tapering is required. The rationale for this approach is that enteral nutrition itself provides a protective effect against stress ulceration by buffering gastric acid and improving mucosal blood flow. Continuing prophylaxis unnecessarily can increase risks of hospital-acquired pneumonia, Clostridioides difficile infection, and potential drug interactions. However, patients with ongoing risk factors such as mechanical ventilation, coagulopathy, or those receiving high-dose corticosteroids may require continued prophylaxis despite enteral feeding. Regular reassessment of the need for stress ulcer prophylaxis should be part of daily ICU care to minimize unnecessary medication use.